OP0180-HPR DOES FOLLOW-UP REALLY MATTER? A MIXED METHODS STUDY EXPLORING PATIENTS’ PERSPECTIVES ON FOLLOW-UP SUPPORT IN REHABILITATION ACROSS LEVELS OF CARE
Authors: G. Berdal, A. L. Sand-Svartrud, A. D. Linge, A. M. Aasvold, K. Tennebø, S. Eppeland, A. S. Hagland, G. O. Fredheim, H. Lindtvedt Valaas, I. Bø, Å. Klokkeide, J. Sexton, M. Azimi, T. N. Dager, I. Kjeken
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Lack of continuity in rehabilitation across levels of care is a known weakness of existing services. The BRIDGE-intervention was developed to improve the quality and continuity of rehabilitation for patients with rheumatic and musculoskeletal diseases (RMDs) by means of goal directed, coordinated, individually tailored follow-up after rehabilitation discharge. The intervention was evaluated in a multi-center randomised controlled trial (the BRIDGE trial) in Norway. <h3>Objectives</h3> The objective of this study was to explore what patients with RDMs need and receive of follow-up support in their municipality of residence after rehabilitation in secondary healthcare, and whether such follow-up impacts on clinical outcomes 1 year after rehabilitation. Further, to compare these findings with patients' experiences with follow-up support to develop a better understanding of how such follow-up works across levels of care. <h3>Methods</h3> The study had a concurrent mixed methods design in which quantitative and qualitative data were collected in parallel, analyzed separately, before integrated into an overall result. All participants in the intervention group (n=168) of the BRIDGE-trial were included. Quantitative data were patient-reported in an electronic portal. Demographic and disease-specific data were collected on admission to rehabilitation. Data on goal attainment (Patient Specific Functional Scale), physical function (30 seconds Sit-To-Stand test), health related quality of life (EQ5D-5L-index), and health status (EQ-VAS) were reported at discharge, 2, 7 and 12 months after rehabilitation. Needs for follow-up were reported at rehabilitation discharge by ticking off a list of 12 predefined options. The patients were categorized into 4 groups based on their needs for follow-up on discharge (yes/no) and the degree of follow-up received according to stated needs the first year after rehabilitation (none/partial/complete). Quantitative data were analyzed using descriptive statistics, ANCOVAs, and linear regression. Qualitative data about patients' experiences with follow-up were collected in semi-structured interviews with 21 patients and analyzed using reflexive thematic analysis. The results were integrated in the overall interpretation and discussion. <h3>Results</h3> The patients most often reported needs for follow-up from General Practitioner, physiotherapist, and social security services, and did mostly receive (&gt; 85%) these services within 1 year after rehabilitation. There were no significant differences between the 4 groups with regard to characteristics at discharge, or clinical outcomes 1 year after rehabilitation. Received individually tailored follow-up was not shown to significantly influence clinical outcomes, and was, surprisingly, associated with reduced patient reported health 1 year after rehabilitation: EQ-VAS β 0.28 [95% CI -0.48, -0.09], p=0.004. The qualitative analysis resulted in three themes: "Contact between service levels" (established through various actors, processes, documents), "Follow-up keeps the rehabilitation process going" (by increasing motivation and focus on goals and self-effort after discharge), and " Loss of momentum' (linked to personal and structural factors). <h3>Conclusion</h3> Patients with RMDs report needs for follow-up from one or more healthcare services after rehabilitation in secondary care. Clinical outcomes 1 year after rehabilitation appeared to be influenced by several other factors than the actual received follow-up support. Health personnel's competence and structural factors across health service levels, such as waiting lists and limited access to care, seemed to be decisive for the progress of the rehabilitation process over time, together with factors related to the individual patient and his/her life situation. The findings can contribute to increased insight into what promotes continuity in rehabilitation processes, effective follow-up, and better health for this patient group. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.